Migraines and Mindfulness Focus of Golden Lecture

By Dirk Hoffman

Rebecca Erwin Wells, MD, is a professor of neurology at Wake Forest University School of Medicine and Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina, where she founded and directs their Comprehensive Headache Program.

She graduated with the highest honors on a full academic scholarship from UNC-Chapel Hill, received her medical degree from East Carolina-Brody School of Medicine, completed a neurology residency at the University of Virginia, and obtained a master’s in public health degree from Harvard University.

Wells completed fellowships in integrative medicine and headache medicine from Harvard.

During her talk titled “Does Mindfulness Help Migraine? My Journey to Understanding This Question,” Wells laid out the steps of her career.

She originally set out to become a clinical pediatrician, but her curiosity of the mind-body connection led her to a different path into neurology.

Wells recalled that when she was in her third year of residency, she was caring for a patient with migraines and none of the medications prescribed for her were helping relieve the symptoms.

“I asked her if she was interested in trying any mind-body options such as guided imagery or deep breathing as an alternative, and the patient said she had never tried that but would love to,” she said.

Wells said she was really proud that what she had suggested resonated with this patient, but when she told a faculty member about it, he sternly replied: “Do not ever recommend something that does not have evidence that it works.”

Wells said that admonishment led her to her research fellowship.

“I realized then that in order for the alternative or mind-body modalities to be considered in Western science, we needed evidence,” she said.

Migraine prevalence and burden is extraordinary, Wells said, noting that it affects 39 million Americans and one billion people worldwide, costs $19 billion annually, and that almost one-third of those who suffer migraines require bed rest.

“Migraines are actually more prevalent than diabetes and asthma,” Wells said. “Stress is the number one trigger for patients with migraines, so if we target stress with interventions of mind-body medicine, maybe we can reduce migraines.”

Wells said “mindfulness” is really a buzzword these days, meaning different things to different people, but she prefers Jon Kabat-Zinn’s definition: “Mindfulness is awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally.”

Kabat-Zinn is the founder of Mindfulness-Based Stress Reduction (MBSR), a standardized 8-week mind-body intervention that teaches mindfulness meditation/yoga.

In 2014, Wells first obtained National Institutes of Health funding in the form of a K23 grant and also received some national recognition when Time magazine published an article titled “Meditation Shortens Migraines By 3 Hours.”

The article was based on a small first-author pilot study published in the journal Headache and led by Wells that aimed to assess the safety, feasibility and effects of the MBSR course in adults with migraines.

The study’s conclusions were that the small sample size (19 subjects) of the randomized controlled trial did not provide power to detect statistically significant changes in migraine frequency or severity, but secondary outcomes demonstrated the intervention had a beneficial effect on headache duration, disability, self-efficacy and mindfulness.

Wells was encouraged by the media attention the study drew — validating her belief that migraines were a topic of interest to many.

Wells was again first author on a 2020 study published in JAMA Internal Medicine titled “Effectiveness of Mindfulness Meditation vs. Headache Education for Adults with Migraine: A Randomized Clinical Trial.”

This study was a randomized clinical trial of 89 adults who experienced between four and 20 migraines per month.

It found that both MBSR and headache education improved migraine frequency, but Wells said it also found that MBSR had meaningful clinical impact in that it improved disability, quality of life, self-efficacy, pain catastrophizing, and depression out to 36 weeks, with decreased experimentally induced pain suggesting a potential shift in pain appraisal.

“We found those in the mindful group had a reduction in their perception of both pain intensity and unpleasantness,” she said. “Mindfulness literally shifted their pain appraisal.”

“We all have stress in our lives. Mindfulness does not change stress, but it changes our response to it.”

Wells obtained an NIH R01 grant in 2022 for her project titled “Online Team Migraine: Online Techniques and Education Aimed to Manage Migraine.”

She said it is similar to her previous study, will be all online, involve national recruitment across the United States and is targeting patients from diverse backgrounds.

Wells noted that Melissa L. Rayhill, MD, clinical associate professor of neurology at the Jacobs School of Medicine and Biomedical Sciences, is a co-investigator on the study. More information may be obtained by emailing Help4Migraine@Wakehealth.edu

Wells closed her talk by quoting from an essay she wrote as a college freshman.

“I don’t even remember writing this, but I said I wanted to become a doctor and I was interested in mind-body medicine. However, I said wanted to be trained in the traditional sense of a medical school. I wanted to be a leader in my field and have the strength to overcome pressure to continue on the traditional path.”

“What struck me in reading this is the realization that I have not strayed from traditional science,” Wells said. “I followed my path and passion.”

The lecture took place Sept. 28 in the M&T Auditorium at the Jacobs School building.

In her opening remarks, Allison Brashear, MD, MBA, UB’s vice president for health sciences dean of the Jacobs School, noted that she was very familiar with Wells from her time serving as chair of neurology at Wake Forest for 14 years.

“I talked to her after her first fellowship in integrative medicine and she said she wanted to do another fellowship in headache medicine, both at Harvard,” she said. “I told her go ahead and then come to Wake Forest, and that is what she did.”

“Rebecca is a role model for investigator and physician development,” Brashear said. “She was very clear in her goals and that she was going to be successful.”

Brashear noted the Golden Lectureship was founded in 2001 to expand the traditional medical model to a bio-psycho-social and spiritual model of care.

“Named for cardiologist Lawrence Golden, MD, and his wife, longtime family therapist Nancy Golden, this lecture reinforces the Golden family’s longstanding commitment to mind-body medicine, which focuses on the interactions among the physical body, thoughts, beliefs and emotions, as well as how they relate to health,” she said.

Nasir Khan, MD, clinical associate professor of medicine, led a Questions & Answers session following the lecture. Grant Golden, MD ’76, provided Wells with a gift to mark the occasion on behalf of his family.